Abstract:
OBJECTIVE:To study the safety of off-label IV thrombolysis in patients with very severe stroke (NIH Stroke Scale [NIHSS] scores >25) compared with severe stroke (NIHSS scores 15-25), where treatment is within European regulations. METHODS:Data were analyzed from 57,247 patients with acute ischemic stroke receiving IV tissue plasminogen activator in 793 hospitals participating in the Safe Implementation of Thrombolysis in Stroke (SITS) International Stroke Thrombolysis Registry (2002-2013). Eight hundred sixty-eight patients (1.5%) had NIHSS scores >25 and 19,995 (34.9%) had NIHSS scores 15-25. Outcome measures were parenchymal hemorrhage, symptomatic intracerebral hemorrhage, mortality, and functional outcome. RESULTS:Parenchymal hemorrhage occurred in 10.7% vs 11.0% (p = 0.79), symptomatic intracerebral hemorrhage per SITS-MOST (SITS-Monitoring Study) in 1.4% vs 2.5% (p = 0.052), death at 3 months in 50.4% vs 26.9% (p < 0.001), and functional independence at 3 months in 14.0% vs 29.0% (p < 0.001) of patients with NIHSS scores >25 and NIHSS scores 15-25, respectively. Multivariate adjustment did not change findings from univariate comparisons. Posterior circulation stroke was more common in patients with NIHSS scores >25 (36.2% vs 7.4%, p < 0.001), who were also more often obtunded or comatose on presentation (58.4% vs 7.1%, p < 0.001). Of patients with NIHSS scores >25, 26.2% were treated >3 hours from symptom onset vs 14.5% with NIHSS scores of 15-25. CONCLUSIONS:Our data show no excess risk of cerebral hemorrhage in patients with NIHSS score >25 compared to score 15-25, suggesting that the European contraindication to IV tissue plasminogen activator treatment at NIHSS levels >25 may be unwarranted. Increased mortality and lower rates of functional independence in patients with NIHSS score >25 are explained by higher stroke severity, impaired consciousness on presentation due to posterior circulation ischemia, and longer treatment delays.
journal_name
Neurologyjournal_title
Neurologyauthors
Mazya MV,Lees KR,Collas D,Rand VM,Mikulik R,Toni D,Wahlgren N,Ahmed Ndoi
10.1212/WNL.0000000000002199subject
Has Abstractpub_date
2015-12-15 00:00:00pages
2098-106issue
24eissn
0028-3878issn
1526-632Xpii
WNL.0000000000002199journal_volume
85pub_type
杂志文章相关文献
NEUROLOGY文献大全abstract:OBJECTIVE:To compare the proportion of APOE ε4 genotype carriers in aphasic vs amnestic variants of Alzheimer disease (AD). METHOD:The proportion of APOE ε4 carriers was compared among the following 3 groups: (1) 42 patients with primary progressive aphasia (PPA) and AD pathology (PPA/AD) enrolled in the Northwestern ...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0000000000008666
更新日期:2020-02-11 00:00:00
abstract:OBJECTIVE:To review the disciplinary process by which the American Academy of Neurology (AAN) enforces its formalized standards of professional conduct. METHODS:We reviewed the AAN's Disciplinary Action Policy. We tracked the elapsed time from receipt to final decision of all allegations ("complaints") of improper con...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0b013e318202014e
更新日期:2010-12-14 00:00:00
abstract:OBJECTIVES:To define CSF β-amyloid 1-42 (Aβ42) cutpoints to detect cortical amyloid deposition as assessed by 11C-Pittsburgh compound B ([11C]PiB)-PET and to compare these calculated cutpoints with cutpoints currently used in clinical practice. METHODS:We included 433 participants (57 controls, 99 with mild cognitive ...
journal_title:Neurology
pub_type: 杂志文章,多中心研究
doi:10.1212/WNL.0000000000002081
更新日期:2016-01-05 00:00:00
abstract:OBJECTIVE:This study aimed to determine the frequency of CNS infection by dengue virus (DENV) in individuals with fatal outcomes. METHODS:Samples of 150 individuals suspect of an infection disease and with fatal outcomes were investigated for evidence of the presence of DENV. The sampling was made up of 150 CSF, 120 t...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0b013e31824b94e9
更新日期:2012-03-06 00:00:00
abstract::We surveyed 297 patients with Parkinson disease (PD) with systematic screens and rigorous definitional criteria. Pathologic hypersexuality lifetime prevalence was 2.4%. Compulsive shopping was 0.7%. Combined with our pathologic gambling data, the lifetime prevalence of these behaviors was 6.1% and increases to 13.7% i...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/01.wnl.0000238503.20816.13
更新日期:2006-10-10 00:00:00
abstract::We performed a clinical study and linkage analysis on 278 subjects (66 affected) belonging to eight families with X-linked dominant Charcot-Marie-Tooth (CMT) neuropathy. This form affects 11.8% of CMT patients in Iowa. Motor nerve conduction velocities (MNCVs) were significantly slowed consistent with type 1 CMT. Fift...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.42.4.903
更新日期:1992-04-01 00:00:00
abstract:OBJECTIVES:Circulating endothelial progenitor cells (EPC) are markers of vascular injury and their numbers decrease in acute stroke. However, the relation of EPC levels to stroke severity has not been quantified. MRI measurements of lesion volume provide an objective method for stroke severity assessment and outcome pr...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0b013e318200d741
更新日期:2010-12-07 00:00:00
abstract::We performed a randomized double-blind crossover therapeutic bioequivalency study of a generic (Epitol) versus a brand name (Tegretol) carbamazepine product under steady-state conditions in 40 epileptic patients. Each patient received 90-day supplies of Epitol or Tegretol and placebo, which replaced the usual dosage o...
journal_title:Neurology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1212/wnl.42.6.1147
更新日期:1992-06-01 00:00:00
abstract:OBJECTIVES:The aim of the current study was, first, to determine the critical causative vestibular areas that in exceptional cases manifest with transient vertigo or dizziness in acute strokes of the middle cerebral artery, and second, to try to explain why in most cases unilateral lesions of these areas manifest witho...
journal_title:Neurology
pub_type: 杂志文章,meta分析
doi:10.1212/WNL.0000000000001501
更新日期:2015-04-21 00:00:00
abstract::We administered a battery of cognitive tests to 41 recently diagnosed Parkinson patients and 41 controls to assess the early neuropsychological changes associated with Parkinson's disease (PD). Parkinson subjects did as well as controls on tasks assessing attention and select language and visuospatial measures. Howeve...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.39.4.557
更新日期:1989-04-01 00:00:00
abstract:BACKGROUND:Previous studies link posterior border-zone cerebral infarcts between the middle cerebral artery (MCA) and the posterior cerebral artery (PCA) to hemodynamic causes, not embolism. OBJECTIVE:To study the cause of these infarcts. METHODS:We studied 21 patients (unilateral = 18, bilateral = 3) with acute, sym...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.53.6.1312
更新日期:1999-10-12 00:00:00
abstract::Vagus nerve stimulation (VNS) is an effective adjunctive treatment for intractable epilepsy. However, the optimal range of device duty-cycles [on/(on + off times)] is poorly understood. The authors performed a multicenter, randomized trial of three unique modes of VNS, which varied primarily by duty-cycle. The results...
journal_title:Neurology
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1212/01.wnl.0000168899.11598.00
更新日期:2005-07-26 00:00:00
abstract:OBJECTIVE:Charcot-Marie-Tooth (CMT) disease is the most common inherited neuromuscular disorder, affecting 1 in 2,500 individuals. Mitochondrial DNA (mtDNA) mutations are not generally considered within the differential diagnosis of patients with uncomplicated inherited neuropathy, despite the essential requirement of ...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0b013e3182698d8d
更新日期:2012-09-11 00:00:00
abstract:BACKGROUND:An inverse association between cigarette smoking and the risk of idiopathic PD has been found in many epidemiologic studies. The therapeutic and possible neuroprotective effects of nicotine formulations on parkinsonian symptoms are controversial. METHODS:In a 12-week, randomized, double-blind, placebo-contr...
journal_title:Neurology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1212/wnl.57.6.1032
更新日期:2001-09-25 00:00:00
abstract::Loading doses of 15 to 20 mg per kilogram of both phenobarbital and phenytoin, administered intravenously, are necessary in the newborn to achieve rapid therapeutic plasma anticonvulsant levels. Maintenance doses of 3 to 4 mg per kilogram of both agents will maintain therapeutic levels. Phenytoin is, however, not pred...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.31.9.1107
更新日期:1981-09-01 00:00:00
abstract:OBJECTIVE:To discuss the indications and timing for resective surgery in patients with Sturge-Weber syndrome (SWS) and medication-resistant epilepsy. BACKGROUND:SWS that causes epilepsy severe enough to merit surgery is rare. Because of the variable natural history of the disease, it is difficult to establish clear-cu...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.55.10.1472
更新日期:2000-11-28 00:00:00
abstract::To assess reversibility of focal cerebral ischemia, we performed a neurologic and pathologic study of 27 monkeys subjected to temporary middle cerebral artery occlusion. An implanted snare ligature occluded the artery in awake monkeys for 30 minutes, 4 hours, 8 hours, 16 hours, 24 hours, or permanently. Serial neurolo...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.31.10.1295
更新日期:1981-10-01 00:00:00
abstract:OBJECTIVE:To identify the genetic and physiologic basis for recessive myasthenic congenital myopathy in 2 families, suggestive of a channelopathy involving the sodium channel gene, SCN4A. METHODS:A combination of whole exome sequencing and targeted mutation analysis, followed by voltage-clamp studies of mutant sodium ...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0000000000007185
更新日期:2019-03-26 00:00:00
abstract:OBJECTIVE:To test the hypothesis that extratemporal neuronal networks are involved in dystonic posturing (DP) observed in mesial temporal epilepsy (MTLE). METHODS:The authors analyzed electroclinical findings in 36 patients with MTLE with or without DP. Three DP types were defined (types I, II, III) corresponding to a...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/01.wnl.0000184510.44808.50
更新日期:2005-11-22 00:00:00
abstract:OBJECTIVE:Quality of neurologic emergency management in an under-resourced country may be improved by standard operating procedures (SOPs). METHODS:Neurologic SOPs were implemented in a large urban (Banjul) and a small rural (Brikama) hospital in the Gambia. As quality indicators of neurologic emergency management, pe...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0000000000004080
更新日期:2017-07-11 00:00:00
abstract:BACKGROUND:No data exist on whether the syndrome of amnestic mild cognitive impairment occurs in the oldest old, or if the relationships for functional status and neuropsychometric performance based on clinical diagnosis hold true in this age group. DESIGN/METHODS:The authors performed comprehensive neurologic evaluat...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.60.3.477
更新日期:2003-02-11 00:00:00
abstract::A 16-year-old male with a 9-year history of spontaneously arrested hydrocephalus was noted to have hydrosyringomyelia and increased intracranial pressure shortly after sustaining minor head trauma. His symptoms resolved completely following ventriculoperitoneal shunt replacement. Hydrosyringomyelia may occur in the se...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.38.4.652
更新日期:1988-04-01 00:00:00
abstract::Using an in vitro blood-nerve barrier (BNB) model, the authors tested the effect of various monoclonal antiganglioside antibodies on BNB function. Only anti-GM1 antibody significantly facilitated BNB leakage in a concentration-dependent, complement-independent manner. This study provided evidence that anti-GM1 antibod...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.55.4.585
更新日期:2000-08-22 00:00:00
abstract::The authors evaluated four patients with schizencephaly who underwent subtraction ictal SPECT coregistered to MRI (SISCOM) prior to epilepsy surgery. Three patients had a SISCOM alteration that was concordant with the epileptic brain tissue. Two of these patients were rendered seizure-free and one individual experienc...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/01.wnl.0000147262.70507.76
更新日期:2004-12-28 00:00:00
abstract::Lyme borreliosis (LB) causes a range of neurologic manifestations, the most common of which is facial nerve paralysis. To evaluate nervous system LB, we organized a neurologic collaborative study group in Suffolk County, NY, a region of high LB incidence. Between July and September 1989, LB serologies were performed o...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.42.7.1268
更新日期:1992-07-01 00:00:00
abstract::The authors report results of SPECT cerebral perfusion studies in two patients with familial dysautonomia (FD) during dysautonomic crises and when clinically stable. SPECT imaging studies used 99mTc ethylene cysteine dimer. During dysautonomic crises, regions in the temporoparietal and frontal lobes had increased upta...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.55.1.122
更新日期:2000-07-12 00:00:00
abstract::We studied performance on tests of visual neglect and left lateral gaze after caloric stimulation in 18 patients with left-sided visual neglect after strokes. Except for one patient with absent vestibulo-ocular responses, all improved during caloric stimulation on the left by cold (LC) or on the right by warm water (R...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.35.7.1019
更新日期:1985-07-01 00:00:00
abstract::We reviewed the historical features, preoperative diagnostic evaluation, operative procedure, and surgical outcome in 16 patients with refractory frontal lobe epilepsy. Clinical expression of the epilepsy varied widely, particularly with respect to seizure characteristics, although high monthly seizure frequency and a...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/wnl.45.4.780
更新日期:1995-04-01 00:00:00
abstract::Migraine, especially migraine with aura (MA), is an established risk factor for ischemic lesions of the brain. Recent evidence has also linked migraine to a broader range of ischemic vascular disorders including angina, myocardial infarction, coronary revascularization, claudication, and cardiovascular mortality. The ...
journal_title:Neurology
pub_type: 杂志文章,评审
doi:10.1212/WNL.0b013e3181a71220
更新日期:2009-05-26 00:00:00
abstract:OBJECTIVE:To study the clinical and radiologic spectrum and genotype-phenotype correlation of 4H (hypomyelination, hypodontia, hypogonadotropic hypogonadism) leukodystrophy caused by mutations in POLR3A or POLR3B. METHODS:We performed a multinational cross-sectional observational study of the clinical, radiologic, and...
journal_title:Neurology
pub_type: 杂志文章
doi:10.1212/WNL.0000000000001002
更新日期:2014-11-18 00:00:00